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There is a significant association between an ACL tear and increased patellar tendon length with a greater Insall-Salvati ratio. The mechanism for this finding is unclear, but this association provides support to suggest relative patella alta may be a risk factor for ACL injuries in pediatric patients.

Carotid artery dissection is a cause of stroke, especially in young and middle-aged patients. A dissection occurs when there is an intimal tear or rupture of the vasa vasorum, leading to an intramural hematoma, which is thought to result from trauma or can occur spontaneously, and is likely multifactorial, involving environmental and intrinsic factors. The clinical diagnosis of carotid artery dissection can be challenging, with common presentations including pain, partial Horner syndrome, cranial nerve palsies, or cerebral ischemia. With the use of noninvasive imaging, including magnetic resonance and computed tomography angiography, the diagnosis of carotid dissection has increased in frequency. Treatment options include thrombolysis, antiplatelet or anticoagulation therapy, endovascular or surgical interventions. The choice of appropriate therapy remains controversial as most carotid dissections heal on their own and there are no randomized trials to compare treatment options.

Bilateral agenesis of the long head of the biceps tendon is an exceedingly rare anomaly and can be a challenging diagnostic dilemma whose differential diagnosis includes tear. We present the third case of bilateral agenesis of the long head of the biceps tendon. Absent or shallow intertubercular sulcus is a constant finding and serves to differentiate this entity from tear. Our case is unique in that there was a radial ray anomaly, where prior reports of bilaterality did not demonstrate associated congenital anomalies. We also describe the newly reported finding of thickening of the rotator cable without the presence of rotator cuff tear. Thickening of the rotator cable may be an associated finding with agenesis of the biceps tendon.

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